Postmenopausal bleeding occurs after a woman has stopped having menstrual cycles due to menopause. Once a woman has gone 12 months without a period, she’s considered to be in menopause. Vaginal bleeding that occurs after that 12-month timeframe is considered postmenopausal bleeding.
In order to rule out serious medical problems, women with postmenopausal bleeding should always see a doctor.
Bleeding can occur in postmenopausal women for several reasons. For example, women who take hormone replacement therapy may have vaginal bleeding for a few months after starting the hormones. It’s also possible for a woman who thought she was in menopause to begin ovulating. If this occurs, bleeding may also occur.
Additional causes of bleeding after menopause include uterine polyps, which are noncancerous growths in the lining of the endometrium. Another possible cause is endometrium hyperplasia, which is the thickening of the endometrium.
Bleeding may also develop due to thinning of the vaginal tissues. This is common in women who are postmenopausal. Thinning often develops due to a decrease in estrogen.
Many women who experience postmenopausal bleeding may not have other symptoms. But symptoms may be present and depend on the cause of bleeding. Women that have postmenopausal bleeding due to thinning of the vaginal tissues may experience pain with intercourse.
The first steps in diagnosing the cause of postmenopausal bleeding are a physical exam and a medical history analysis. A doctor may conduct a Pap smear as part of a pelvic exam. This can also screen for cervical cancer.
Doctors may use other procedures to view the inside of the vagina and the uterus.
One option is a transvaginal ultrasound. This procedure allows doctors to view the ovaries, uterus, and cervix. In this procedure, a technician inserts a probe into the vagina, or asks the patient to insert it herself. The probe emits sound waves that bounce off of inner structures. A computer then creates pictures of the inner structures.
Another diagnostic procedure is a hysteroscopy. This procedure shows endometrial tissue. In this procedure, a doctor inserts a fiber optic scope into the vagina and cervix. The doctor then pumps carbon dioxide gas through the scope. This helps to expand the uterus and makes the uterus easier to see. During this procedure, a doctor may also remove polyps or take a biopsy of endometrial tissue in order to rule out cancer.
Treatment depends on the cause of the bleeding, on whether bleeding is heavy, or if additional symptoms are present. In some cases, bleeding may require no treatment. In other situations, where cancer has been ruled out, treatment may include the following:
- Estrogen creams: Your doctor may prescribe estrogen cream if your bleeding is due to thinning and atrophy of your vaginal tissues.
- Polyp removal: Polyp removal is a surgical procedure.
- Progestin: Progestin is a hormone replacement therapy. Your doctor may recommend it if your endometrial tissue is overgrown. Progestin can decrease the overgrowth of tissue and reduce bleeding.
- Hysterectomy: Bleeding that cannot be treated in less invasive ways may require a hysterectomy. During a hysterectomy, your doctor will remove the patient’s uterus. The procedure may be done laparoscopically or through conventional abdominal surgery.
If bleeding is due to cancer, treatment will depend on the type of cancer and its stage. Common treatment for endometrial or cervical cancer includes surgery, chemotherapy, and radiation therapy.
Postmenopausal bleeding is successfully treated in many cases. If your bleeding is due to cancer, the prognosis depends on the type of cancer and stage at which it was diagnosed. The five-year survival rate is about 95 percent when endometrial cancer is detected early and hasn’t spread.